Botulinum Toxin for Head Tremor
The term tremor refers to an intentional rhythmic movement of part of the body. When most people think of a tremor, they imagine a shaking of the hands, but tremor can affect almost any body part, including the head.
What’s Causing Your Head Tremor?
The treatment of head tremor depends on its cause. Perhaps the most common cause is essential tremor, an inherited tremor that can affect the hands and head. Unfortunately, Up to 30 to 50 percent of people diagnosed with essential tremor actually have other diagnoses. One often-overlooked cause is cervical dystonia. Cervical dystonia is probably the most common type of focal dystonia, an involuntary contraction of muscles. When those muscles are in the neck, the head twists in one direction, and the unconscious urge to straighten the neck back out can cause a tremor. This is also known as spasmodic torticollis.
Because cervical dystonia is treated in a very different fashion than essential tremor of the head, it’ s important to have a clear diagnosis. Some physicians believe that when a patient lies flat, an essential head tremor will resolve, but spasmodic torticollis may persist, though this may not always be the case. In one study, about 30 percent compared to over 90 percent improvement in essential head tremor.
There are a few other ways to distinguish between essential tremor and spasmodic tremor. For example, essential tremor usually involves other parts of the body as well, such as the arms, and is worse when the person tries to use the affected body part. If the voice seems tremulous, essential tremor is more likely than spasmodic torticollis. Spasmodic torticollis is associated with a feeling of the head twisting, which is not usually true of essential tremor. Essential tremor is also unlikely to be painful, whereas spasmodic torticollis may be so. Many dystonias, such as spasmodic tremor, respond well to what doctors call a “sensory trick,” meaning that the muscle contraction sometimes relaxes after touching part of the body. This does not occur in essential tremor.
How Can Head Tremor Be Treated?
There are many possible ways of treating head tremor, depending on the tremor’s cause and severity. For example, essential tremor can often be treated with the medications propranolol or primidone. If these medications fail to help, other options such as local injections of botulinum toxin may be considered. Essential tremor that makes the head shake in a “no-no” is better treated with botulinum toxin than tremor that shakes the head in a “yes-yes” direction. In contrast to essential tremor, focal dystonias such as torticollis generally doesn’t respond well to oral medications, and botulinum injections are considered the best initial therapy. Botulinum toxin is very effective in helping with cervical dystonia, benefitting between 70 to 94 percent of patients.
Botulinum toxin works by weakening the communication between nerves and muscles. It does this by blocking the release of the neurotransmitter acetylcholine from the end of the nerve. This effectively makes the muscle weaker, and makes tremor more manageable. The goal of treatment with botulinum toxin is not to cure the cause of the tremor, but to improve the symptoms. Injections need to be repeated periodically for the benefit to be sustained.
Low dose injections of botulinum toxin are generally well tolerated. Potential side effects include weakness of the neck muscles which can lead to a head droop. Occasionally there can be some difficulty swallowing, especially if the botulinum toxin is injected into the muscles at the front of the neck. Sometimes people also describe feelings of headache or pain at the site of injection.
In cases where botulinum toxin is ineffective, more invasive options such as deep brains stimulation can be considered. It’s important to recognize that despite occasional side effects, injections of botulinum toxin are generally very safe over several years. For this reason, a trial of botulinum is certainly advisable in the treatment of head tremor prior to pursuing more invasive methods.
Patient Reactions to Treatment
Head tremor can be an embarrassing and disabling condition. Botox injections can markedly reduce head tremor, even when oral medications have failed. Learn More →
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If you have marked disability and medications have been unsuccessful, deep brain stimulation may be a good option. Learn More →
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